Healthcare Provider Details

I. General information

NPI: 1205375284
Provider Name (Legal Business Name): TYMESHA PENDLETON PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: T. ANTONIA PENDLETON PSY.D.

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 TOWERVIEW DR
DURHAM NC
27708-9979
US

IV. Provider business mailing address

405 MOURNING DOVE CT
MEBANE NC
27302-8797
US

V. Phone/Fax

Practice location:
  • Phone: 516-428-6948
  • Fax:
Mailing address:
  • Phone: 516-428-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5577
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: